Eficácia da fisioterapia no tratamento das incapacidades pós concussão em atletas: revisão crítica da literatura

Abstract

Concussion is defined as a mild traumatic brain injury, which can lead to cognitive, physical, emotional and somatic symptoms. The mechanisms of injury are related to contact or head collision with enough force to generate a cerebral shaking and are commonly observed in contact sports such as football, rugby, lacrosse and soccer. Several are the symptoms and disabilities resulting from concussion. In addition, the losses caused to the athlete can be both personal and professional, and may cause him to withdraw from the sport for long periods. Thus, the objective of the study was to investigate the efficacy of physiotherapy in acquired disabilities after concussion. The study deals with a critical review of the literature according to the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta - Analyzes). The research was carried out in the MEDLINE / SciELO / PEDro / Cochrane / Lilacs databases using a search strategy consisting of the combination of terms referring to: concussion, athlete, physiotherapy and experimental studies. The inclusion criteria were: to perform post-concussion physiotherapy treatment, to include basic or professional athletes of any gender and age and to have been published in any language until March 2016. The methodological quality of the studies was evaluated by the PEDRo scale. A total of 135 studies were found, of which four were selected that have met the inclusion criteria, two (50%) classified as having a high methodological quality, one (25%) of moderate methodological quality and one (25%) of low methodological quality, according to the PEDro scale. Considering the intervention used in the experimental group, only one (25%) used combination therapy of vestibular rehabilitation and physiotherapy for cervical spine, two (50%) aerobic exercises on the stationary bicycle and only one (25%) controlled and progressive exercise to 80% of the maximum heart rate on the treadmill. Half of the studies (50%) evidenced the efficacy of post-concussion physiotherapy treatment. The outcomes that improved after physiotherapeutic treatment were medical release time for return to sports, brain activation, precision, and cognitive speed. The other half, two (50%), who used aerobic exercise on the stationary bicycle, did not present in their results a statistically significant difference between the experimental group and the control group. It was concluded that the physiotherapeutic treatment using combined therapy of vestibular rehabilitation and physiotherapy for cervical spine together with the protocol of controlled and progressive exercise at 80% of maximal heart rate on a treadmill were effective to improve the medical release time for the return to the sport, improvement on brain activation and regulation of cerebral blood flow in post-concussion athletes. No study has shown deleterious results of physical therapy treatment in post-concussion individuals. Therefore, the classic consensual recommendation of physical and cognitive rest for the treatment of post concussion athletes should be reviewed and discussed. Considering the small number of studies found that investigated the effectiveness of physiotherapy in the treatment of post concussion athletes, further studies are needed.